Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The effect of foetal and early childhood growth on metabolic derangements of Sri Lankan children

Abstract Background Previous studies have shown that delayed prenatal growth followed by accelerated postnatal growth plays a significant role on the onset of adult metabolic diseases. The present study aimed to identify the effects of intrauterine and later growth on metabolic derangements among children in Colombo, Sri Lanka. Methods A school-based cross-sectional study was conducted among 5–15-year-old children selected using a two-stage probability-proportionate-to-size cluster sampling technique. Birth-weight (BW) was extracted from records (denotes prenatal growth) and body mass index(BMI)-Z score and fat mass(FM) measured to denote the current growth of children. Fasting and random blood glucose, lipid profile and blood pressure(BP) were measured. The sample was stratified by age (5—< 10 and 10—15 years); was further categorized into tertiles of BW and BMI-Z scores. Based on these two parameters, metabolic parameters were evaluated within each age category. Results The sample comprised 833(494 boys) healthy school children. Metabolic parameters did not significantly differ by sex or across BW tertiles of each BMI-Z score tertile. However, significant changes in some metabolic parameters were noted across the BMI-Z score tertiles of each BW tertile. Children belonging to the lowest BW and highest BMI-Z score tertiles had worst metabolic profiles, while those in the lowest BW as well as BMI-Z score tertile were protected. Excessive fat deposition seemed to move children to higher BMI-Z score tertiles. Conclusion Poor prenatal growth is not the sole risk factor for abnormal metabolic profile found in childhood. Those who gain fat, denoted by weight, during early childhood are at a higher risk of developing metabolic abnormalities than those who do not. This favours the accelerated postnatal growth hypothesis

Validity of currently used cutoff values of body mass index as a measure of obesity in Sri Lankan children

Objective The aim of the study was to determine the reliability of body mass index based (BMI) cutoff values in diagnosing obesity among Sri Lankan children. Methods Height, weight, waist circumference (WC) and hip circumference (HC) in 282 children were measured. Total body water was determined by deuterium dilution and fat mass (FM) derived using age and gender specific constants. A percentage FM of 30% for girls and 25% for boys were considered as cutoff levels for obesity. Results Two hundred and eighty two children (M/F: 158/124) were studied and 99 (80%) girls and 72 (45.5%) boys were obese based on % body fat. Eight (6.4%) girls and nine (5.7%) boys were obese based on International Obesity Task Force (IOTF) cutoff values. Percentage FM and WC centile charts were able to diagnose a significant proportion of children as true obese children. The FM and BMI were closely associated in both girls (r=0.82, p < 0.001) and boys (r=0.87, p < 0.001). Percentage FM and BMI had a very low but significant association; girls (r=0.32, p < 0.001) and boys (r=0.68, p < 0.001). FM had a significant association with WC and HC. BMI based cutoff values had a specificity of 100% but a very low sensitivity, varying between 8% and 23.6%. Conclusions BMI is a poor indicator of the percentage fat and the commonly used cutoff values were not sensitive to detect cases of childhood obesity in Sri Lankan children

Development of height-weight based equation for assessment of body composition in Sri Lankan children

Objective To develop a height and weight based equation to estimate total body water (TBW) in Sri Lankan children. Methods Cross sectional descriptive study done involving 5–15 year old healthy children. Height and weight were measured. TBW was assessed using isotope dilution method (D2O) and fat free mass (FFM) calculated. Multiple regression analysis was used to develop prediction equation and validated using PRESS statistical technique. Height, weight and sex code (male=1; female=0) were used as prediction variables. Results This study provides height and weight equation for the prediction of TBW in Sri Lankan children. To the best of our knowledge there are no published height weight prediction equations validated on South Asian populations. Conclusion Results of this study need to be affirmed by more studies on other closely related populations by using multicomponent body composition

Use of Skin-Fold Thickness in Sri Lankan Children: Comparison of Several Prediction Equations

Objective: There are many prediction equations available in the literature for the assessment of body composition from skinfold thickness (SFT). This study aims to cross validate some of those prediction equations to determine the suitability of their use on Sri Lankan children. Methods: Height, weight and SFT of 5 different sites were measured. Total body water was assessed using the isotope dilution method (DO). Percentage Fat mass (%FM) was estimated from SFT using prediction equations described by five authors in the literature. Results: Five to 15 year old healthy, 282 Sri Lankan children were studied. The equation of Brook gave Ihe lowest bias but limits of agreement were high. Equations described by Deurenberg et al gave slightly higher bias but limits of agreement were narrowest and bias was not influence by extremes of body fat. Although prediction equations did not estimate %FM adequately, the association between %FM and SFT measures, were quite satisfactory. Conclusion: We conclude that SFT can be used effectively in the assessment of body composition in children. However, for the assessment of body composition using SFT, either prediction equations should be derived to suit the local populations or existing equations should be cross-validated to determine the suitability before its application